Medicare fraud often originates with unscrupulous providers who bill the government for illegitimate services or supplies, or for pricier care than the patient received. However, scammers can also target consumers directly in order to access their benefits or deceive them into paying for fraudulent coverage.
In one common scam, fraudsters pretending to be from the Centers for Medicare & Medicaid Services claim that a target's coverage will be canceled unless they pay for a new Medicare card. Another tricks an individual into revealing their Medicare number, which criminals use to access care or facilitate further fraud.
"These scams can be hugely harmful in more ways than one," explains Chris Kawashima, CFP®, director of financial planning at the Schwab Center for Financial Research. "For example, legitimate health care requests can be denied because of bogus claims for similar services—and fraudulent diagnoses, tests, or other misinformation in your health records can lead to improper care."
So, how can you protect yourself against such scams?
- Guard your identity: Be proactive in protecting sensitive information. A scammer with your Medicare or Social Security numbers, for example, can leverage them for widespread fraud. "If someone purporting to be from a government agency calls to pressure you for your personal information, that should raise an immediate red flag," Chris says. "When in doubt, hang up and call the government agency's publicly published contact number."
- Watch your statements: Keep track of the medical equipment, services, and tests you receive and check them against your Medicare Summary Notices (if you have Original Medicare) or Explanation of Benefits (if you have Medicare Advantage or a stand-alone Part D plan). Report suspicious activity to your provider or the Centers for Medicare & Medicaid Services at 800-MEDICARE (800-633-4227).
- Get outside help: Senior Medicare Patrol (SMP) is a federal program with trained volunteers who can help detect and avoid scams. Find the SMP in your state.
Another reason to be vigilant? "Medicare loses approximately $60 billion a year to abuse, errors, and fraud,1 and those costs are passed on in the form of higher taxes and insurance premiums," Chris says. "It's in all of our interests to fight these practices."
1"Medicare Fraud by the Numbers," Senior Medicare Patrol National Resource Center, 2024.
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